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317:30-5-211.10.Durable medical equipment (DME)

[Revised 09-01-15]
(a) DME. DME includes, but is not limited to: medical supplies, orthotics and prosthetics, custom braces, therapeutic lenses, respiratory equipment, and other qualifying items when acquired from a contracted DME provider.
(b) Certificate of medical necessity. Certain items of DME require a CMN/OHCA CMN which should be submitted with the request for prior authorization. These items include, but are not limited to:

(1) hospital beds;

(2) support surfaces;

(3) patient lift devices;

(4) external infusions pumps;

(5) enteral and parenteral nutrition;

(6) Oxygen and oxygen related products; and

(7) pneumatic compression devices.

(c) Prior authorization.

(1) Rental. Rental of hospital beds, support surfaces, oxygen and oxygen related products, continuous positive airway pressure devices (CPAP and BiPAP), pneumatic compression devices, and lifts require prior authorization and, except for CPAP and BiPAP devices, a completed CMN/OHCA CMN; medical necessity must be documented in the member's medical record, signed by the physician, and attached to the PA.

(2) Purchase. Equipment may be purchased when a member requires the equipment for an extended period of time.  During the prior authorization review, the OHCA may change the authorization from a rental to a purchase or a purchase to a rental based on the documentation submitted.  The provider must indicate whether the DME item provided is new or used.

(d) Backup equipment. Backup equipment is considered part of the rental cost and is not a covered service without prior authorization.
(e) Home modification. Equipment used for home modification is not a covered service.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.